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Item Adverse Childhood Experiences (ACEs) and their Impact on Substance Misuse & Overall Health(The Center for Health Policy, 2018-03-01) Balio, Casey; Greene, Marion S.Adverse childhood experiences (ACEs) encompass a wide variety of distressing events, including emotional, physical, or sexual abuse; witnessing maternal domestic violence; or living with a household member who has a substance use disorder, is mentally ill or suicidal, or is currently or was ever incarcerated during the first 18 years of a child’s life. According to most recent estimates, nearly half of Indiana’s youth have experienced at least one ACE in their life. ACEs are linked to many risk behaviors, including substance use, which can adversely affect health outcomes.Item Co-occurring Substance Use and Mental Health Needs: Enhancing the Adult Needs and Strengths Assessment (ANSA) to Manage Services(2019-10-04) Walton, Betty A.; Kim, Hea-WonSubstance use disorders (SUD) are common, affecting one in 25 adolescents (ages 12 -17), one in seven young adults (ages 18 to 25), and one in 16 adults (ages 26 and older) during 2017. 1 While 16.7% of adults without SUD experienced mental health (MH) disorders, 45.6% of adults with SUD experienced co-occurring MH disorders.1 Related research found much higher rates of adults with MH or SUD disorders (50-75%) have co-occurring disorders. 2, 3, 4, 5 Co-occurring MH and SUD make treatment more difficult, increase use of health resources, and interfere with individuals’ life functioning.2, 3, 4 In response to the opioid crisis, SUD treatment funding and services are expanding. Effective treatment requires identification of co-occurring disorders (COD). The goal of this study was to examine how well practitioners assess and identify COD in practice.Item Daily Experiences of Racial Microaggressions and Health Outcomes Among Black Adolescents: A Daily Diary Study(2023-08) Clifton, Richelle Lee; Zapolski, Tamika C. B.; Stewart, Jesse C.; Johnson, India R.; Aalsma, Matthew C.Racial microaggressions are associated with multiple negative health outcomes, including increased distress, anxiety (Blume et al., 2012; Schoulte et al., 2011), and substance use (Su et al., 2019). The negative effects of racial microaggressions have been observed through daily assessments (Burrow & Ong, 2010; Ong et al., 2009; Swim et al., 2003). However, these studies have been conducted almost exclusively among Black adults. Thus, the first aim of the current study is to examine the impact of daily experiences of racial microaggressions on health outcomes among Black adolescents. Further, it is also important to examine factors that might influence the relationship between racial microaggressions and health outcomes. One factor that has received a considerable amount of attention is racial identity, with more recent studies examining the impact of racial identity profiles. Thus, the second aim of the current study was to explore variability in these risk pathways based on racial identity profiles. Participants were Black adolescents (N = 48; 79.2% girls; Mage=17.13). Respondents completed measures of racial identity at baseline and daily diary measures of racial microaggressions, depression, anxiety, aggression, and substance use for 14 days. Participants reported an average of 5.56 experiences of racial microaggressions per day. Neither concurrent or lagged-day associations between racial microaggressions and symptoms of depression or symptoms of anxiety were significant. Concurrent analyses indicated that the between-person effect of racial microaggressions on aggression was significant (estimate=0.345, SE=0.138, t=2.495, p=0.016), and that effect was still evident one day later (estimate=0.107, SE=0.040, t=2.686, p=0.007). The concurrent, within-person effect of racial microaggressions on cannabis use was also significant (OR=1.524, 95%CI[0.103, 0.740], p=0.010). Four racial identity profiles were identified (labeled race- focused, undifferentiated, integrationist, and multiculturalist) and a number of effects were significant within profiles. This study further highlighted that Black youth are experiencing an overwhelming number of racial microaggressions on a daily basis. Additionally, this project represents a crucial step in advancing our understanding of how racial microaggressions operate to influence health outcomes among Black adolescents on the daily level and highlights several areas for needed study and intervention.Item The Impact of Parental Incarceration on Children’s Health & Development(The Center for Health Policy, 2018-12-01) Balio, Casey; Greene, Marion S.The incarceration boom in the United States has resulted in high rates of parents serving time. According to recent estimates, one in ten Hoosier children has a parent who is or has been in prison or jail. Though incarceration is often treated as a discrete event, it is important to note that the time period extends both prior to and beyond the incarcerated phase (pre- and post-incarceration). Evidence on the relationship between parental incarceration and various children’s outcomes is inconsistent across the literature and often disappears when controlling for demographic and family characteristics. However, whether the relationship between parental incarceration and children’s health and development is causal or simply correlational, this population is at high risk for adverse outcomes and should be the target of interventions.Item The Impact of Substance Use on the Developing Brain(The Center for Health Policy, 2017-07-01) Kooreman, Harold E.Most peoples’ first exposure to alcohol, tobacco, and other drugs typically occurs during adolescence, a time when the brain changes rather dramatically. The maturation process of the adolescent brain is reflected in a greater propensity to take part in risky activities such as unprotected sex, reckless driving, and substance use. Alcohol, nicotine, and marijuana, the most commonly used substances by teens, have all been tied to disruptions in normal brain development. These structural changes are associated with higher rates of cognitive impairments and academic difficulties, higher rates of future substance use and substance use disorders, and higher rates of mood and psychotic disorders.Item A Latent Class Analysis of Vaping, Substance Use and Asthma Among U.S. High School Students: Results from the Center for Disease Control's Youth Risk Behavior Survey(2021-07) Zervos, Andrew Peter; Hensel, Devon J.; Foote, Carrie E.; Steensland, BrianRates of vaping among high school students have increased significantly over the past decade. Prior research has found significant associations between youth vaping and substance use. However, little is known about how vaping is associated with various patterns of polysubstance use and asthma in youth. We aimed to identify how youth are best categorized into classes based on co-occurring vaping and polysubstance use behaviors, how these classes are associated with youth background and demographic characteristics, and if these classes significantly predict asthma outcomes. Our sample consisted of nationally representative data from the 2017 and 2019 waves of the Youth Risk Behavior Survey (N = 28,442). We utilized Latent Class Analysis, multinomial logistic regression analyses, and binary logistic regression analyses to examine relationships between youth vaping, polysubstance use, and asthma. Three latent classes of substance use were identified: Polysubstance Users, Lifetime Alcohol and Vape Users, and Abstainers. Age, gender, grade and race were all significantly associated with odds of membership in the Polysubstance Users class, compared to the Abstainers class. Sexual identity was not associated with class membership. Membership in the Polysubstance Users class was significantly associated with higher odds of asthma, as compared to membership in the other two classes. These findings indicate that recent vaping is associated with high probabilities of recent polysubstance use. They also suggest that youth with high probabilities of vaping and polysubstance use are at significantly high risk for asthma compared to other classes vi of youth users and non-users. We recommend that future youth intervention strategies be tailored differently toward different classes of substance use and vaping. Future research should examine how the classes of vaping and substance use that we identify emerge in youth and what social factors (e.g., peer behavior, parental connectedness, etc.) influence their development.Item Mapping Recovery: A Qualitative Node Map Approach to Understanding Factors Proximal to Relapse Among Adolescents in Recovery(2020-12) Whitt, Zachary T.; Cyders, Melissa A.; Zapolski, Tamika; Salyers, MichelleDespite data suggesting that current substance use disorder treatments are largely effective in reducing substance use, most adolescents in SUD treatment experience relapse after finishing treatment. Understanding the factors proximal to relapse is crucial to understanding the course of substance use disorder and how best to improve recovery among adolescents. The current study represents part of a novel line of research using qualitative data analysis to examine these factors. Data for the present study were 200 de-identified node-maps, completed by high school students at Hope Academy, a recovery high school in Indianapolis, Indiana. The reported age in this sample ranged from 14-20 years (64.1% male, 89.1% White), with a mean age of 16.8 years (SD = 1.9 years). After a four-phase process of qualitative data sorting, primary people, places, and things most frequently described included using with others (n=153, 76.5%), away from home (n=156, 78.0%), and in response to negative affect (n=93, 48.4%). Eleven relapse pathways emerged: escaping (n=16), self-medicating (n=3), coping with tragedy (n=5), critical mass (n=6), unexpected activation (n=8), unexpected offer (n=22), planned use (n=19), resistant to recovery (n=5), not in recovery (n=22), passive agency (n=30), and acting out (n=15). Recovery is a system made up of many interrelated parts, including those related to the individual person in recovery, their thoughts, beliefs, feelings, and emotions; and those related to external factors, their environment, adverse life events, and the actions of other people. By considering the pathways together for their common features, they can each be said to represent one of three critical failures related to those three overarching facets of the system: failure to cope, failure to guard against temptation, and failure of belief. Identifying these overarching failures in the system is helpful because the failures contain in themselves the seeds of their solution, so by examining them as critical components to a relapse event, it may be possible to gain insight into how to prevent the same type of relapses from occurring in the future.Item Medicated-Assisted Treatment in Indiana(The Center for Health Policy, 2019-03-01) Kooreman, HaroldOpioid misuse and addiction continues to affect many Americans. Medication-assisted treatment (MAT) using methadone, buprenorphine, or extended-release naltrexone in combination with behavioral therapy is the most effective intervention for opioid use disorders (OUDs). Despite its effectiveness, methadone to treat OUDs is not widely available. Buprenorphine is more accessible, as it can be prescribed by medical doctors, nurse practitioners, and physician assistants who have received specialized training and obtained a waiver from the DEA. Naltrexone is a non-narcotic and can be prescribed by any healthcare professional who has prescription privileges.Item Recovering from Substance Use Disorders: A Case for Peer Recovery Coaches(The Center for Health Policy, 2019-01-01) Jacinto, Corey; Greene, Marion S.Peer recovery coaches (PRCs) are resources that are being increasingly utilized in the treatment of substance use disorders (SUDs). The role of a PRC is to act as mentor, guide, and role model to those with an SUD by providing a range of support services. The overall body of evidence suggests that PRCs can be effective; however, barriers to the widespread utilization of the peer-recovery approach still exist.Item Suicide Prevention(The Center for Health Policy, 2020-01-01) Gutta, Jyotsna; Heniff, Lauren; Greene, Marion S.Suicide, or intentional self-harm, is one of the leading causes of death in the United States. Suicide rates among Hoosiers have increased from 12.6 per 100,000 in 2008 to 16.3 per 100,000 in 2017, a nearly 30% increase over the 10-year period. One in ten Indiana high school students attempted and survived suicide; those who identified as gay, lesbian, or bisexual had significantly higher rates of suicide-related thoughts and behaviors compared to students who identified as heterosexual. A variety of factors contribute to a person’s likelihood to engage in suicidal thoughts and behaviors. Though anyone can be affected by suicide, there are some groups within the population that are at a particularly high risk due to the stresses they experience. The purpose of this report is to provide an overview of suicide risks, trends, and current interventions in Indiana. To accomplish this, we (1) reviewed the literature and existing data, (2) conducted key informant interviews with state experts, and (3) synthesized the information to provide recommendations for suicide prevention.